Young fighters home from war often battle two demons: post-traumatic stress and the lure of a drink — or a dozen — to soothe their fried nerves.

As a group, Americans in their 20s are prone to binge drinking, no matter their job history.

But alcohol abuse interferes with treatment of post-traumatic stress disorder, leaving many veterans largely ineligible for what’s believed to be the best version of therapy.

Now, researchers at San Diego’s U.S. Department of Veterans Affairs hospital are launching a five-year study to see if the strongest PTSD therapy can be used on heavy drinkers at the same time as they are being helped to ease their grip on the bottle.

“We don’t have a gold standard yet for how to treat someone who has both PTSD and alcohol problems,” said Sonya Norman, the VA psychologist in La Jolla leading the study. “People across the country are looking at this issue in various ways. People understand that it’s a very big problem.”

A study of 339 San Diego veterans showed that 19 percent reported a combination of PTSD and substance abuse. People in the San Diego veterans community say it may be much higher, as high as 50 percent. VA data for Vietnam veterans shows that 60 percent to 80 percent of those seeking PTSD treatment have problems with alcohol abuse.

Miguel Delgado, a former Navy hospital corpsman who twice deployed to Iraq, has been through several kinds of therapy for combat stress. He used to depend on alcohol to blot out the terrifying memories they stirred up.

“All of those therapies I went through brought back very strong feelings and emotion, things I was suppressing,” said Delgado, 50, who retired in 2006 after 26 years of service.

“I would come home and drink. My drinking got so bad, I found myself in the garage of my own house, crying. And I knew something was wrong,” he said. Nearly three years ago, he decided to get help for alcoholism and has been sober ever since.

The treatment that most triggered the former sailor’s drinking is the one that Norman hopes to prove can work for veterans with alcohol issues.

It’s called prolonged-exposure therapy. Some people compare it to cleaning out a festering wound so it can heal.

The treatment involves talking about traumatic combat experiences in order to process them at a deep level. The desired result is that the veteran feels the distress and realizes that it gradually decreases. As homework, patients are asked to do things they’ve been avoiding — going to crowded events, for example — to learn that it is safe.

Norman, who since 2007 has directed the San Diego VA’s PTSD clinic for Iraq and Afghanistan veterans, describes this therapy and a similar one called cognitive processing therapy as the front-line treatment.

“The recovery rates are better than anything else we have,” she said.

But, right now, veterans with drinking problems are being herded away from the exposure technique until they get control of their drinking. Instead, they are steered toward coping skills, a gentler framework that teaches methods for dealing with distress, including alcohol avoidance.

Norman said that therapy — named Seeking Safety at the La Jolla VA — is popular among therapists because it’s easier to learn. As a result, it is offered widely.

“That’s where we are now. We have two treatment models,” she said. “There’s this thing that’s far more accessible, but is it as good? That’s not clear.”

Norman’s $700,000 study, funded by the VA, will examine the two approaches head-to-head for the first time. Veterans in exposure treatment would get counseling for alcohol simultaneously.

Research on another traumatized population — women with addiction and psychiatric disorders — makes Norman think that veterans with drinking problems can handle the more rigorous therapy.

The women whom Norman studied found that exposure therapy gave them the most relief.

“They were very satisfied with their treatment. They weren’t saying, ‘I can’t look at the memory, I’m too fragile for this.’ They were saying, ‘thank you,’ ” said Norman, who is also an assistant professor in UC San Diego’s psychiatry department.

The results of her new study may be nowhere better used than in San Diego County, home to the largest concentration of post-Sept. 11 veterans in the country. The La Jolla-based VA regional medical system serves more than 30,000 Iraq and Afghanistan war participants.

Delgado, the former Navy corpsman, said he is skeptical that intense therapy has much chance if someone is drinking heavily.

“Now I realize that I could not continue to drink and get the treatment that I needed. Because I needed to be all there,” said the Oceanside resident, who is now using his GI Bill toward a bachelor’s degree at National University.

But many young veterans may be like Matthew Quijas, a 26-year-old former Marine who fought in Afghanistan in 2010.

Back home in Kansas City after discharge, the former infantryman was tossing back drink after drink with friends until he couldn’t remember anything. He knew it wasn’t a good life, so he returned to San Diego and is receiving help through the VA for PTSD.

But Quijas isn’t giving up alcohol. Now he cuts it back to weekends or a couple beers with dinner, he said.

He acknowledges, though, that discussing his war experience nudges him toward the six-pack.

“I know that when I talk about things that bother me and make me upset, and I go out drinking later on, more than likely I’m going to have a bad night. Real bad,” the Grossmont College student said. “I’m not going to stop until I’m done drinking.”

Nationally, the VA is on a hiring drive for mental health workers following years of criticism that the mammoth federal agency has been slow to react to the needs of Iraq and Afghanistan veterans suffering from combat trauma.

In April, the agency announced it will add 1,600 additional mental health workers and 300 support staffers across the country. That declaration came one day before an internal inspector general’s report that said the VA’s measurement of wait times was largely bogus — leading critics to describe the hiring announcement as an attempt at damage control.

A federal appeals court on May 7 reversed an earlier decision that would have pushed the VA to dramatically overhaul its mental health care system. A year ago, a three-judge panel of the 9th U.S. Circuit Court of Appeals ordered the VA to ensure that suicidal vets are seen immediately. It found the VA’s “unchecked incompetence” in handling the flood of PTSD and other mental health claims to be unconstitutional.

In San Diego, VA officials say that 95 percent of patients seeking mental health care receive it within 14 days, citing data for the past seven months. The clock starts the day the patient asks for care, spokeswoman Cindy Butler said.

There’s also a psychiatric emergency clinic where the patient can been seen that day, she said, and the emergency department is open all hours.